Routine monitoring of outcome over 11 years in a residential behavioural psychotherapy unit.

BACKGROUND

Though research trials have to rate clinical outcome, few units monitor outcome of their routine care over many years. We report such monitoring to evaluate therapy over time and under changing operating and economic conditions.

METHOD: Clinical outcome data were collected routinely over 11 years in a behavioural psychotherapy unit whose residential patients mostly had severe, chronic obsessive-compulsive disorder (OCD) treated by self-exposure therapy. Data were from 218 referrals during 4 of the 11 available years.

RESULTS

In each of the 4 time periods, the patients improved consistently and highly significantly by 30-50% on symptoms and disability, which resembled outcome in a multi-centre controlled trial. There were almost no significant differences in pre-treatment ratings between patients who attended follow-up, patients who completed residential treatment but not follow-up and those who did not complete residential treatment. When the unit became a hostel and the UK government introduced an internal market, more chronic patients were admitted who often lived far away.

CONCLUSIONS

The fact that successive OCD cohorts had improved comparably by discharge suggests there was no 'burn-out' in staff standards of care over 11 years, and no loss of gains when the unit became a more cost-effective hostel.